Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 6 Approach To A Neck Mass PPT-Powerpoint Presentations and lecture notes
Approach to a Neck Mass
Objectives
? Develop a Diagnostic Approach
? Review Differential Diagnosis
? Case-Based Review
History ? Important Points
? Mass itself:
? Duration, ? Size or character change since noticed
? Associated symptoms:
? Pain, sensory loss, epistaxis, dysphagia, hoarseness,
hemoptysis, cold/heat intolerance, hearing change...
? Social history:
? Smoking, chewing tobacco, alcohol
? Past medical history
? Radiation*, skin cancer/lesion
? Family history *
Physical Examination
? Take the time to be thorough
? Inspection:
? Exterior scalp, face, ear
? oropharnyx, hypopharnyx, larynx, nasal passage
? External Ear
? Flexible fiberoptic endoscopy
? Palpation -- External & Bimanual
? Mass, thyroid, lymph node levels, oropharnyx,
salivary glands
? Relation to swallowing/tongue protrusion
Fine Needle Aspiration
? Often the first diagnostic test
? Simple and highly sensitive
? No longer felt to risk spread of tumor
? Technically demanding sometimes *
? Don't forget US guidance can be helpful
? Cytopathologist is key
Lab Tests & Imaging
? Play a smaller role than usual
? Blood work??
? C.T. scanning
? Large/complicated mass
? ? Remote primary
Differential Diagnosis Simplified
? Congenital Lesions *
? Salivary Gland Lesions *
? Thyroid Gland Lesions *
? Lymph Nodes *
Triangles
of the
Neck
Anterior
Submandibular
Submental
Carotid
Posterior
Triangles of the Neck
? Anterior
? Submandibular
? Submandibular gland
? Submental
? Dermoid, ranula
? Carotid
? Branchial cleft cyst, Carotid Body Tumour
? Posterior
? Lipoma, Neurogenic tumor
? * Lymph node lesions can be anywhere *
Lymph Nodes
? Inflammatory
? Lymphoma
? Metastatic
? Site of the node can help localize the primary
? Supraclavicular nodes can be non head & neck 10
? Breast & Lung most common
? GI tract, Prostate, Testicular
? Eponym*
Lymph
Node
Levels
Memorial
Sloan-
Kettering
Lymph Node Level
Likely Primary Site
Cases
7 Year Old Boy
? Small lump middle of neck
? Asymptomatic
? Otherwise healthy
? Physical
? 1.5cm, firm lump middle neck
? Moves up with tongue protrusion
? What now?
? ? FNA ? Eponym
65 Year Old Man
? Asymptomatic 2 cm lump Right submandibular
triangle
? Chews tobacco, no EtOH
? Remainder history negative
? Physical
? 2 cm firm lump ? Submandibular gland on Bimanual
? Remainder negative
? FNA ? Mucoepidermoid Ca
? What now?
38 year old Woman
? Asymptomatic
? Referred by GP for neck nodes
? History entirely negative
? Physical
? Multiple nodes levels 3 & 4 Right side
? Small nodule Right Thyroid
? Likely Diagnosis?
? FNA ? Papillary Ca
? What now?
56 Year Old Man
? Asymptomatic Lump Left Neck
? Heavy Smoker, occasional EtOH
? No past history or family history
? Physical Exam
? Hard lump L neck anterior triangle
? Otherwise negative despite being thorough
? FNA ? Squamous Cell Carcinoma
? What Now?
A 43-year old man notes shortness of breath. He
is a non smoker. His wife points out that his face
has become slightly swollen. On examination, his
blood pressure is normal. His pupils are equal and
respond to light. Dilated veins are noted around
the shoulders, upper chest, and face. An x-ray of
the chest reveals an opacity in the superior
mediastinum. What is the most likely diagnosis?
(A) Thymoma
(B) Neurogenic tumor
(C) Lymphoma
(D) Teratodermoid tumor
This 19 year old girl had a
two-week history of a
painless swelling in the left
jugulo digastric region.
FNAC demonstrated benign
squamous cells, cellular
debris and cholesterol
crystals. CT scan
demonstrated a well
circumscribed cystic mass,
anterior to the
sternomastoid muscle. This
is a typical ?
This young woman had a
one-week history of a
rapidly enlarging mass in
the upper right neck with
localised tenderness. The
CT scan again
demonstrates a well
circumscribed unilocular
cyst, with a smooth wall
This young man has a
prominent painless lymph node
in the jugulodigastric region.
Fine needle aspiration biopsy
indicated a diagnosis of
Hodgkin's Disease. The 40
year old man (inset) has a lump
in an identical position, also
painless and present for months.
Fine needle aspiration biopsy
confirmed the diagnosis of
metastatic squamous cell
carcinoma from a tonsil cancer.
He was a non smoker.
The man is 60, a heavy smoker
and presents with a hoarse
voice and large mass in the
right upper neck. Fine needle
aspiration biopsy showed
necrotic debris and the CT scan
demonstrates a unilocular
cystic mass. The cyst wall is
irregular and this is metastatic
squamous carcinoma, which
has undergone cystic
degeneration. The primary
cancer was in the hypopharynx
This man has
nasopharyngeal carcinoma
with multiple metastatic
lymph nodes in the
posterior triangle,
bounded by the clavicle
below, sternomastoid
muscle anteriorly and the
trapezius posteriorly..
The young man had a
firm, but not hard
submandibular swelling
which had been present
for 5 years. The CT scan
on the right demonstrates
a midline dermoid cyst.
This is a well localised
benign congenital lesion.
This young woman, aged
25, has a well localised
swelling just below the
hyoid bone, which elevates
on protrusion of the tongue.
The CT scan on the right is
from another patient but
demonstrates identical
pathology of a well
circumscribed cystic
structure lying anterior to
the thyroid cartilage -
thyroglossal cyst.
This young woman has a
prominent right thyroid
nodule. The appropriate
investigations are FNAB
and serum TSH.
This boy, aged 14,
presented with a cystic mass
in the left submandibular
region. Needle biopsy
demonstrated the presence
of mucoid material and the
CT scan shows a cystic
mass lying anterior to the
left submandibular salivary
gland. This is a typical
plunging ranula and is due
to extravasation of mucoid
saliva from the sublingual
gland
This elderly man has a
large left submandibular
mass. An SCC of the
cheek was removed a year
earlier. FNAB showed
metastatic SCC and the
CT scan demonstrates a
large cystic mass with a
septum, consistent with
metastatic cancer.
This 45 year old Asian
woman, recently migrated
to Australia, presented
with a supurating mass in
the right submandibular
region. A diagnosis of
tuberculosis was made
following culture of tissue
from the mass
Questions/Comments
This post was last modified on 08 April 2022